An explanation with translation taken from the government website Moncloa and translated into English. The modification of the RDL approved on Friday, July 27, 2018. Published today Monday July 30 2018.
“The counsel of Ministers today has approved he Real Decree-law on Universal Access to the System National from Health (SNS), from the proposal from the minister from Health, Consumption and Wellness Social, Carmen Heap.
*The ruling guarantees the protection of sanitary care in the same terms to all the people that find themselves in the Spanish State. Thus permitting the normalisation of Sanitary Assistance to those who were excluded in the RDL 16/2012 executed by the government of the PP.
The represents a change from model in the Attention sanitary in Spain. The right to assistance in the National Health System is based on the condition of citizenship and its recognition is therefore separated from the insured status. The access to the Attention sanitary in terms of equality is a right to all people.
In her intervention at a press conference the advice from Minister, Carmen Heap has highlighted that “Spain enjoys a quality public health system of which we feel very proud”, and that today is strengthened by recovering the universal character of this service. “This implies achieving the goal set by Minister Ernest Lluch in the General Health Law of 1986, the norm that laid the foundations of one of the pillars of the welfare state.”
*The RDL recognises as holders of the right to health protection and health care for people with Spanish nationality and foreigners who reside in Spain.
Also those persons who do not have their habitual residence in Spanish territory have recognised their right to healthcare in Spain by any other legal title, such as Spanish pensioners who do not reside in Spain, displaced workers or cross-border workers.
*Groups that are not registered or authorised as residents of Spain will have the right to health protection under the same conditions as people with Spanish nationality.
In order to not compromise the financial sustainability of the National Health System and avoid the inappropriate use of the right to healthcare, with respect to these groups, health care will be charged to the public funds of the competent administrations provided that the following requirements are met:
Not having the obligation to prove the coverage of health care by other means, by virtue of the provisions of EU law, bilateral agreements and other applicable regulations.
Not being able to export the right to health coverage from your country of origin or provenance.
There is no third party obliged to pay
In any case, health care for these groups does not generate a right to health coverage outside Spanish territory financed from public funds.
The CCAA (Autonomous Community), within the scope of its powers, will set the procedure for the application and issuance of the certification document that accredits foreigners rights in order to receive assistance.
In those cases in which foreign persons have not exceeded the period of temporary stay referred to in Law 4/2000 on Rights and Freedoms of Foreigners in Spain and their Social Integration (90 days), the issuance of a report will be mandatory prior agreement of the competent social services of the Autonomous Communities.
In the elaboration of the norm, the reports and considerations made by the international organisations (the European Commission, the Council of Europe, the World Health Organisation) have been taken into account.
Have also incorporated Information provided by the autonomous communities, the Ombudsman, scientific societies or civil society in the various meetings held in recent weeks for the development of the RDL. The norm is the result of an intense process of dialogue maintained with these entities and organisations.
“The essence of this rule,” said the minister, “and what justifies the urgency of addressing the universality of health care, is the improvement of the individual health of excluded people and the collective health of the entire population A just society leaves no one behind. ”
On the other hand, this regulation provides coordination, harmonisation and legal security before the dispersed regulations of the Autonomous Communities. *To preserve health care for groups that were left out of the National Health System by RDL 16/2012, The Autonomous Communities prepared different provisions to cover excluded populations. The new RDL will put an end to the legal insecurity that affects both the people who need health care and the professionals who provide this public service, as well as the administrations that approved them in their day.
The application of the standard does not imply a higher cost for public coffers. Standardised care in primary care allows better control of diseases and public health, and prevents decompensation in diseases that cause urgent care and hospitalisations. Therefore, in addition to the gain in individual and collective health, it is less burdensome for the health system”.
Interpretation from CAB senior advisers with prior knowledge of the law of 2012 referred to which included the right to healthcare and the provision of the same by the INSS (Institute of Social Security).
*It is important to note the sentence “Thus permitting the normalisation of Sanitary Assistance to those who were excluded in the RDL 16/2012 executed by the government of the PP”. Those that were excluded in the Royal Decree were those immigrants without papers so not legal residents in Spain. On reading the disposition of this law, it is notable that the words “all peoples” is used. It also states that there should be no discrimination and EU citizens are included. This may not stop the INSS from interpreting the articles to the advantage of the social security system.
The RDL of 2012 included the right to healthcare for ALL residents including those who were not insured either by employment or other means as long as they legally resided in Spain. Also the law that excluded those not legally residing in Spain. This had not stopped the INSS from using their internal instructions making April 2012 a cut off date for free healthcare for residents.
Relevant extract from the law:
Article 3 below is from the existing RDL showing right to healthcare for all. This is not new. It is in this law where illegal immigrants and those without residency status were excluded.
Article 3 Of the insured status
1. Health care in Spain, charged to public funds, through the National Health System, will be guaranteed to those persons who hold the condition of insured.
2. For these purposes, those who are in any of the following cases will have the status of insured:
a) Be an employee or self-employed worker, affiliated with the Social Security and in a situation of discharge or assimilated to the discharge.
b) Hold the pensioner status of the Social Security system.
c) To be the beneficiary of any other periodic Social Security benefit, including unemployment benefit and subsidy.
d) To have exhausted the benefit or the unemployment subsidy and appear registered in the corresponding office as job seeker, not proving the insured status by any other title.
3. In those cases in which none of the previously established cases is fulfilled, persons of Spanish nationality or of any Member State of the European Union, of the European Economic Area or of Switzerland residing in Spain and foreigners holding an authorisation to reside in Spanish territory, they may hold the status of insured provided they prove that they do not exceed the income limit determined by regulation. (no limit).
The above shows that all resident of Spain are entitled to healthcare cover under the NHS. So we can say the modification of Article 3 (below) unlikely refers to those who are legal residents of Spain. The RDL published today Monday July 30 2018 is the RDL 7/2018, de 27 de julio
«Article 3. Holders of the right to protection of health and health care.
1. They are holders of the right to health protection and health care
all persons with Spanish nationality and foreign persons who
they have established their residence in Spanish territory.
Notwithstanding the foregoing, persons entitled to health care in
Spain in application of the community regulations for system coordination
of Social Security or of bilateral agreements that include the provision of
health care, they will have access to it, provided they reside in the territory
Spanish or during their temporary travel to Spain, in the form, extension
and conditions established in the indicated community or bilateral provisions.
2. To make effective the right referred to in section 1 charged to
the public funds of the competent administrations, the holders of
The aforementioned rights must be in one of the following cases:
a) Have Spanish nationality and habitual residence in Spanish territory.
b) To have recognized his right to health care in Spain by
any other legal title, even if they do not have their habitual residence in the territory
Spanish, provided there is no third party obliged to pay for such assistance.
c) Being a foreigner and with legal and habitual residence in the territory
Spanish and not have the obligation to prove the mandatory coverage of the benefit
health in another way.
3. Those persons who according to section 2 do not have the right to
health care charged to public funds, may obtain such benefit
through the payment of the corresponding consideration or fee derived from the
subscription of a special agreement.
4. The provisions of the previous sections of this article do not modify the
health care regime of the holders or beneficiaries of the
special regimes managed by the General Mutual Society of Officials
Civil of the State, the General Judicial Mutuality and the Social Institute of the Forces
Armed, who will maintain their specific legal regime. ”
Three. Article 3b, which is drafted in the following terms, is modified:
«Article 3 ter. Protection of health and health care for people
foreigners who are in Spain do not have their legal residence in the
1. Foreign persons not registered or authorised as residents of
Spain have the right to protection of health and health care in the
same conditions as people with Spanish nationality, as
established in article 3.1.
2. The aforementioned assistance will be charged to the public funds of the
competent administrations provided that said persons comply with all
a) Not having the obligation to prove the mandatory coverage of the benefit
health in another way, under the provisions of European Union law,
bilateral agreements and other applicable regulations.
b) Not be able to export the right to health coverage from your country of origin
c) There is no third party obliged to pay.
2. The healthcare referred to in this article does not generate a right
to the coverage of health care outside Spanish territory financed with
charge to public funds of the competent administrations, without prejudice to the
provided in the applicable international social security standards.
Again note as in the previous law, EU citizens should comply with their regime as in 2 a) above. We suggest that those who are not able to avail of healthcare via the EU Directive route, should also have the right to apply. Simplified that those from the EU where their country is not obliged to pay for their healthcare. This would include early retirees and those who have had to take out private healthcare or register with the Convenio Especial (opting to pay for NHS cover).
There may be options for those with no legal residence to apply for this healthcare but we can offer no guarantees for EU citizens. (There is also reference to not having overstayed 90 day in Spain). The allocation of health cards is by application to the autonomous communities where applicants reside. If we look at Valencia and Catalonia, they have already included EU citizens legally resident in Spain or not, in the right to free healthcare.
CAB can only suggest that those who who are in a irregular situation and wish to apply go ahead quoting the Decreto Real which has been published today. Those already residents could also apply quoting the information from the previous and this modification of the Royal Decree.
Note* Understand that it is not easy for members to plough through the articles. Basically all residents have always been entitled to healthcare if not insured due to employment or S1. This is a modification for those irregulars. We think that with this royal decree, the INSS offices may find it difficult to continue with their internal agreements of denying healthcare to those post April 2012 residents.
Update* for those who are registered for the Convenio Especial.
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